Summary
www.show.scot.nhs.uk/ehealth/
This
draft strategy went out for consultation in December 2003
and is currently being confirmed – up to date details
are on the SHOW web site. It is a key document in determining
how AHP information needs will be part of the overall eHealth
structure. This summary paper highlights the key themes
for AHPs.
Partnership for Care states …
“Our goal is to deliver an Integrated Care Record jointly managed
by patients and professional NHS staff with in-built security
of access governed by patient consent.”
Why?
Partnership for Care goes on to say …
“Integrated Care Records
will take time to reach, but each step in their development
will bring immediate benefits to patients, carers and healthcare
professionals by enabling:
¨
greater patient involvement
in their own care;
¨
service redesign and the
shift in the balance of care provided in different settings;
¨
quicker exchange of information
between professionals;
¨
quicker
access to patient records (with built-in patient confidentiality);
and
¨
continuous improvement by providing routine monitoring of quality
standards.”
and
“We
urgently require an eHealth culture to be established, driven
by clinical leaders.”
and
“eHealth funds and information support staff will be
organised in a way that supports operational systems critical
to the care process.”
But Partnership for Care extends to partnership with
local authorities to develop more person centred and integrated
care in the community. This particularly applies to services
provided to older people including single shared assessment
and to children where the intention is to improve the co-ordination
of children’s care services through an integrated Children’s
Services Record developed in partnership with local authorities
and other relevant agencies.
We need to start by unpicking these ideas
and concepts.
The key aim is that information must flow as part of the many and various
journeys through the NHS and the other caring agencies that
patients can take. Integrated – or Shared - Care Records
are therefore about integration of information at four key
levels:
1.
Local GP/ specialty electronic patient records, such as GP system or A&E
system or AHP systems or a diabetic or cancer record, linked
if appropriate to the Local Integrated Care Record.
2.
Local Integrated Care Record: NHS board-wide information
system holding test results, clinical letters and summaries
of care contributions. These may give a clinician a “view”
across all the specialty systems which have current information
about the patient to be archived in the SCI Store repository.
3.
National
Integrated Care Record: NHSScotland-wide based on the SCI
Store information repository and holding copies of information
from other national systems such as immunisation as well
as summaries of information from the Local Integrated Care
Record.
4.
A
fourth category of record is particular to information shared
between the caring agencies under agreed protocols, eg.
for care of the elderly or children.
The strategy document aims at a rounded and
balanced approach to the development of eHealth recognising
that, whilst IM&T is important, many other issues, particularly
around staff and working practice, patient needs and confidentiality
need to be addressed. The definitions of each term are:
Information Management
& Technology is about the information which NHSScotland
needs to deliver effective healthcare, the technology needed
to deliver that information to the right person at the right
time, and the range of processes such as training and support
services needed to make it happen.
eHealth encompasses
much more than the deployment of computer technology. It
conveys the message of electronics in support of health
and stimulates thought and discussion about the broad range
of issues and opportunities that technology offers in the
health care setting to both healthcare professionals and
patients.
The eHealth objectives now are to:
1. Progressively
integrate, improve and deliver key information to the point
of active care and self care.
2. Lead
through the clinical and patient agendas.
3. Build
commitment and collaboration between all stakeholders, and
address all elements which make for success.
4. Build
upon mandatory national components such as CHI and SCI Store.
5. Address the
lack of equity and modern systems across NHSScotland through
collaborative and supported procurement and development.
These aims and the need for a rounded approach translate into seventeen
‘key elements’ which will be addressed, as depicted
in the diagram below
To
ensure coherent progress a new eHealth Programme Board chaired
by Minister for Health and Community Care has been established.
Four Steering Groups report to this Board, each majoring
on appropriate key elements/ areas for action from the list
above.
¨
Clinical Information Group CMO
led, focus on clinical information development
(Clinical Leadership, Clinical Datasets, Decision
Support)
¨
Patient
Information Group CNO led, focus on patient information
development (provision of information - patient and service)
¨
IM&T
Infrastructure Group NHS Board Chief Executive led, focus
on information delivery (Technology, IM&T support, Training,
Business IT, Telecommunications, Identification)
¨
eHealth in Practice Group Centre
for Change & Innovation, focus on information use (Working
Practices, Innovation, Benefits realisation)
The
four Steering Groups will develop Action Plans and sets
of audit measures which will be monitored both nationally
and for NHS Boards through the Performance Assessment Framework.
As a way of making the complexities and
breadth of the strategy more graspable, the Action Plans
will also be represented as ‘road maps’. On targets
within this Strategy, there are difficulties due to the
variable baseline across NHSScotland. The approach is furthermore
about incremental improvement rather than big bang. Notwithstanding,
the Action Plans will contain targets in the form of audit
measures, and it can be stated that for the priority areas
the following targets will apply …
Local GP/ specialty electronic patient records
1.
Complete national procurements for Community Dentistry and
A&E systems and roll out to all areas with a requirement
over 2004/5.
2.
Develop a national specification for clinical improvements
to GP systems and ensure all suppliers upgrade and roll
out over 2004/5.
3.
Initiate a rolling programme of national collaborative system
procurements followed by implementations, specific systems
to be decided through consultation.
Local Integrated Care Record
4.
Clinical access to online test results via SCI Store in
all GP practices and wards by end 2004.
5. SCI Store’s patient record to be enhanced with the
inclusion of clinical letters, developed and tested by spring
2004 and rolled out thereafter.
6.
Patient Summaries, including current medication, to be electronically
replicated in SCI Store for look-up by clinicians working
with patients out of hours, eg. GPs, A&E.
7.
Continue implementation of shared record to support diabetes
care through SCI-Diabetes Collaboration.
8.
Implement SCI Gateway for referral and discharge letter
communication by summer 2005.
9.
Develop/ procure and implement systems to support Coronary
Heart Disease care by summer 2004.
National Integrated Care Records
10.
Integrated online children’s health record developed
and tested for roll out by September 2004, pulling together
information from systems such as birth record, immunisations,
screening and special needs.
11.
Develop new SCI Index and synergise with local indexes to
support CHI-based identification by summer 2005.
12.
Complete development of new Cervical Cytology system and
roll by end 2006.
eCare records
for multi-agency care
13.
First technical products, including a joined up network
and shared client contact details, available for test sites
by autumn 2003. Live running of all products by end of 2003,
in one site.
14.
Nine local authorities with an eCare store, and first phase
linkages to back office systems by end of March 2004. Sixteen
by end of March 2005. All local projects complete by end
of March 2005.
Other
15.
Develop a mental health information strategy by summer 2004.
16.
Agree a final strategy for the management of cancer information
by summer 2004.
17.
Progress strategy to obtain necessary workforce information
in the short/medium term by implementing the ‘Budgetscan’
system and achieving a national minimum dataset. For the
longer term commercial enterprise products may be required.
18.
Re-procure NHSnet by summer 2004 then implement nationally.
19.
Re-procure national payroll system by spring 2005 then implement.
What this strategy might look like
AHP eCHIP Project
This project commenced in October 2003
and is based in the Primary Care Division, of the Scottish
Executive Health Department.
Current information about Allied Health
Professional Activity has long been recognised as inadequate.
The electronic Community Health Information Project (eCHIP),
aims to develop and improve Community Health Information,
which will include all integrated AHP information. Within
the eHealth stratgey it is not only about central statistical
returns but about developing a reliable and robust set of
information that supports clinical care and is useful to
the patient and health care professionals. This information
can also be used for management and service developments
purposes, to inform strategy and policy decisions and to
support resource allocation decisions.
The purpose of the project is to achieve
consensus among AHPs on a modern, reliable and robust set
of information that meets the need of the clinician especially
in the clinical effectiveness arena as well as managers
and policy makers alike whilst also meeting the information
needs of the patient. This set of information will replace
current AHP central statistical returns. The timescale of
the project has identified that it is only a summary AHP
information dataset that can currently be developed.The
work of the project is informed by and informing other national
information programmes to ensure an integrated approach
within the context of national policy.
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